How to cope with endometriosis and manage it moving forward

Endometriosis can be a challenging condition to deal with, both physically and emotionally. But with proper interventions and proper management and treatments after diagnosis, you can be shown how to deal with the associated symptoms of endometriosis and improve your quality of life. Please have a read of some of the best ways to cope with endometriosis.

Endometriosis can be painful disorder that is characterized by tissue that behaves like the lining of the uterus but that grows outside the uterus. Endometriosis is really normal tissue growing in abnormal places. This tissue can be found in various places, such as the ovaries, fallopian tubes, and pelvic lining, and even in or around the bladder and bowel.

Endometriosis affects around 1 in 10 women and girls and those are only the ones diagnosed. This mean these figures are grossly under-diagnosed and downplayed with many women not being diagnosed properly and those that do not even know they have the disease. Endometriosis can cause symptoms during the reproductive years, between the ages of 12 and 60, but it can show up in young girls under 10 years old too.  Many people with the condition remain undiagnosed and many more and missed and dismissed with many taking up to ten years or more to be diagnosed.

The main symptom of the condition is usually pelvic pain typically associated with the menstrual period. While women can experience some discomfort during their menstrual period, some of those with endometriosis describe pain that is worse than usual. For some it is actually unbearable. There are also other symptoms such as painful periods, pelvic pain, ovulation pain, pain with sex, chronic fatigue, irritable bowel like symptoms, bladder issues and pain and bleeding on bowel movement. This is why all women need to know that period pain is not normal, because many times, period pain can actually be a sign that a woman has an underlining gynaecological conditions such as endometriosis

There is no cure for endometriosis (not yet anyway), but there are treatment options and lifestyle changes that can ease your symptoms so that the condition does not interfere with your day-to-day life. The main thing with endometriosis is to manage the disease and try and create a quality of life moving forward. While there is no cure for endometriosis, it is possible for women to become asymptomatic (meaning having no symptoms) and this requires the right treatments and management of the disease and to see the right people from the beginning. Again, it all gets back to who you are seeing and their experience with knowing about endometriosis. This is one the biggest issues women face when trying to get treatment. Many just do not know much about the disease at all and why women are left to deal with the horrible symptoms. But with the right treatment and management, women can have a better life and be able to cope with this horrible disease.

Before we look at proper management for women with endometriosis, it is important that all understand the facts because there is so much misinformation out there and this is part of the bigger issue for women with this disease.

The Facts About Endometriosis

  1. Period Pain IS NOT Normal
  2. A significant portion of women with Endometriosis are asymptomatic
  3. Symptoms DO NOT correlate to the extent of the disease
  4. The only way to diagnose Endometriosis definitely is via surgical intervention
  5. There is NO cure for Endometriosis
  6. Having a baby will not cure endometriosis
  7. Endometriosis does not always cause infertility
  8. Endometriosis is Estrogen Driven and is not caused by Estrogen dominance
  9. The Pill, or Contraceptives DO NOT fix endometriosis
  10. You can have Endometriosis at a Young, or Older Age
  11. Hysterectomy does not cure endometriosis
  12. Endometriosis requires a multi-modality approach to be managed properly. You need a team for proper management
  13. Endometriosis IS NOT an autoimmune disease
  14. There Are Hereditary and Genetic links
  15. Endometriosis can cause many other issues in the body
  16. The first line approach for hormone therapy should be the use of progesterone only options
  17. Endometriosis needs to be excised (cut out) by an advanced laparoscopic surgeon, who has had extra years of specialised surgical training, and who specialised in the excision of the disease and specialised in the disease itself. Surgery should be performed by anyone other than an advanced laparoscopic surgeon and not by just a regular gynaecologist
  18. Not all women with endometriosis have suffered sexual abuse

 

What Women Can Do To Help Manage Endometriosis

1.Seeing the Right Specialist & Surgeon

First and foremost make sure you have seen someone who specialises in endometriosis and the management and treatments moving forward. You also need to make sure that your first surgery is your best surgery and that you have seen an advanced laparoscopic surgeon to ensure you have had the proper surgical intervention. This is many women’s biggest issue as they have not seen the proper surgeon initially and they aren’t seeing someone who specialises in the management of the disease moving forward.

2.Watch your diet

Eating the right foods may provide some protection from the symptoms of endometriosis. The role of diet in endometriosis has been investigated in recent years due to the influence of diet on some of the processes linked to the disease, such as inflammation, prostaglandin metabolism, and estrogen activity. Many of the so called endometriosis diets out there are now outdated and have outdated nutritional and dietary advice that don’t really help much at all. Women need to adopt an anti-inflammatory (grain free, primal, ketogenic style diet) to help with settling any inflammation in the body and also helping the immune system. This also needs to include prebiotic and probiotic bacteria to help with digestive function, immunity and gut health.

Certain environmental estrogens such as preservatives, plastics, pesticides and insecticides that can be ingested through certain nutrients have been suggested as risk factors for exacerbating endometriosis too.

Excess body fat, now known as obestrogens (because it is estrogenic) needs to be controlled and managed through diet and exercise too. We know that estrogen drive endometriosis and that any estrogens (dietary, body fats, environmental etc) needs to be regulated and controlled.

3.Boost intake of omega-3 fatty acids

Researchers have also found that the type of fat included in your diet makes a difference in your risk of endometriosis. Studies have shown that people whose diets were heavily laden with trans fats increased their risk of the expression of endometriosis by 48 % when compared with individuals who ate the least of these. By comparison, women whose diets were rich in omega-3 oils lowered their risk of endometriosis by 22 % compared with those who consumed the least amount.

Eating foods high in omega-3 fatty acids, such as salmon, flaxseeds, almonds, and walnuts, may be helpful for endometriosis. Women should also be supplementing with Omega 3 oils too. Just remember, it is all about reducing inflammation.

4.Exercise

Often, people who experience pain fear exercising, in case it causes more problems for them. But over time, regular physical activity may decrease the pain and discomfort that you feel. High-intensity exercise and resistance training can help to reduce the symptoms of endometriosis.

Exercise may help those with endometriosis in many ways, including:

  • encouraging the circulation of blood to your organs
  • maintaining nutrients and oxygen flow to all your body systems
  • decreasing estrogen production
  • reducing stress
  • releasing endorphins in the brain, which are pain-relieving, “feel good” chemicals

Women who regularly exercise may be likely to have the symptoms associated with endometriosis. Research has shown that those who engage in frequent high-intensity physical activity have fewer symptoms of  endometriosis than women who do not participate in regular exercise. High-intensity physical activity, such as running, swimming, weight training etc, may be beneficial for reducing your symptoms.

Low-intensity exercise, including Yoga and Pilates may provide some relief in endometriosis, too. Yoga and Pilates can stretch and strengthen your muscles, help with core strength, help with circulation, which all may be beneficial for pelvic pain management and stress reduction.

5.Managing Stress Levels

Stress is a big factor in any disease and can make any disease worse. Not only can stress be exacerbated by endometriosis, but so can endometriosis symptoms be exacerbated by stress, in a never-ending cycle. Endometriosis could contribute to making your stress levels worse, due to the impact that the associated symptoms have on all aspects of your life, including family and personal relationships and work.

Stress management, Counselling, Mindfulness and Relaxation techniques can help to reduce stress that exacerbates endometriosis-related symptoms and pain.

Women with endometriosis need to manage stress by using mindfulness and relaxation techniques. These can help you to increase your awareness of your body, refocus on something calming, and reduce the activity of stress hormones and inflammation in the body. It is all about learning coping mechanisms and what works best for you, not what works best for others.

6.Try complementary medicine and therapies

Many women with Endometriosis find symptom relief from using a range of different complementary and alternative medicines. The Royal College of Obstetricians and Gynaecologists also recommends that women try natural medicines to help with the management of endometriosis and the associated symptoms. There is now some good research to support many natural medicines treatments such as acupuncture, Chinese herbal medicine, vitamins, omega 3 oils, probiotics, chiropractic/osteopathy, yoga, pilates and more.

Out of all the natural medicine therapies, Acupuncture and Chinese medicines has been the most researched and have shown to be the most beneficial to those suffering this disease and its associated symptoms.

Certain strains of prebiotics and probiotics have also been shown to help with the immune system, microbiome, bowel, and digestive associated symptoms of endometriosis. Probiotics have also been shown to not only help with digestive and immune function, but also with the psychological function as well. It does need to be specific strains of probiotics though.

Just like with medical treatments, when it comes to complementary medicines, it is important to find someone who is a qualified practitioner and who specialises in endometriosis. Just like in the medical model, this can also be hard to find.

7.Medications

Your endometriosis specialist can provide you with a list of treatment options for endometriosis and outline the risks and benefits of each. They will take into account your age, your symptoms, whether you want to become pregnant, and any treatments that you have had previously. It is important to manage pain and inflammation so that you can have a life and to be able to function daily.

You may need to use different forms of pain medications on script, as well as those that can be purchased over the counter. Please ensure you speak to your healthcare provider about setting up a pain management plan when using medications

You will also need to look at hormone therapy to help slow down the growth and expression of the disease and microscopic implants and also help with the associated symptoms of the disease. Hormones will usually be in the form of progesterone only medications and gonadotropin-releasing hormone antagonists and agonists. You may be prescribed other hormones depending on your individual case and symptoms.

Although all of these hormone therapies are effective at treating endometriosis, but,  they all have different side effects. You need to talk to your doctor and pharmacists about the side effects and risk factors of any medications and hormones that you are taking.

In Summary

It is important to know that women with endometriosis will need a multi-modality, or team approach to deal with this disease. The team you need and modalities that you will need will be dependent on your individual symptoms. Try and find healthcare professionals that can offer you a multi-modality approach for ongoing care and support and who also have a team of other people who specialise in the disease too. Again, the approach that you and your specialist choose to take will vary depending on your signs and symptoms, and whether or not you would like to become pregnant in the future.

Before starting any treatment, it is important to know all of your options and the potential outcomes of all of them and to know that the people that you are seeing are specialists in endometriosis and know how to manage the disease properly. That can often be the hardest thing to find and why you need to do your homework and see people who are specialists in this area of medicine.

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

-Period Pain IS NOT Normal

 

Incontinence, Bladder issues and Weak Pelvic Floor

Incontinence is often an embarrassing condition that will have more than a third of people suffering in silence because they are too embarrassed to seek treatment. Both men and women can suffer incontinence. Although patients don’t die of incontinence, they often can’t live a fully productive life, they may have to curtail their workload or change jobs. Many factory workers and school teachers are only allowed set times for toilet breaks, so patient with urge incontinence may have to change jobs. Patients who work in the military or the police force may have to resort to desk jobs. Too many women with incontinence stop having sexual intercourse, either because they are afraid they will leak during sex, or else they actually do leak, either at penetration, or at time of orgasm, which can be very disastrous. While men can also suffer incontinence, I am mainly going to focus on the causes of incontinence in women for this post.

Many people don’t seek treatment because they also believe that surgery is their only option. Nothing could be further from the truth and surgery should only be used as a last resort once conservative methods have been used and aren’t working. Even then, the surgical approaches used today are less invasive, are very effective and the recovery is very quick. It is not like it was 10-20 years ago. Keyhole surgery has really made major changes in this area and new surgical techniques are so highly effective.  I know people want to avoid any surgery, but sometimes it is needed and these days the recovery rates are so quick. A few days out of your life for recovery, can actually change your whole life. I just do not understand why anyone would put up with a life with incontinence, prolapse, or weak pelvic floor, when these issues are so easily fixed these days. I know many patients are so amazed at how easily their incontinence issues was fixed and how amazing they feel in getting their life back again. No more leakage when they laugh, cough, or exercise.

Some people never seek treatment believing that incontinence is just a normal part of life. Again, this is not true and all and I encourage anyone with incontinence to come and talk to me, or you pelvic floor specialist, so we can help treat you and can also refer you to the right people for treatment and management if needed. I know my pelvic floor/urodynamic surgeon is amazing and what he can do for women and these issues is amazing too. Then I just help with the management and strengthening moving forward.

Like I said before, surgery isn’t always needed. Many times conservative measures such as pelvic floor exercises, core strengthening, bladder toning, topical estrogen therapy, internal TENS (electrostimulation) and pulse magnetic therapy can all product fantastic long term treatment to this often debilitating condition, without the need for surgery. There are also some special rings and other devices that can be used to prevent leakage and support prolapsed bladder and also vaginal prolapse causing incontinence. Men with incontinence also have options at hand and these can also be explored well before surgery is needed. What people need to be aware of too, is that if you have been doing all the conservative treatments, and they aren’t helping, then it is time to get some surgical intervention. I think people think that pelvic floor exercises with fix all bladder and pelvic floor issues, and this doesn’t work, then there is nothing that can be done to help them. I need for all women (and men) to know that there is always help for bladder and pelvic floor issues and you just need to see a specialist, not just your GP.

On a natural medicine level, acupuncture has been shown to be very effective in the treatment and management of pelvic pain, prolapse and incontinence. Anyone with incontinence should be using acupuncture as part of their overall management. There are also Chinese herbal medicines that can help with toning the pelvic floor and bladder to help stop incontinence. Yoga and Pilates may also help toning of the pelvic floor and help managing incontinence, pelvic floor and post-surgical management of prolapse too.

Incontinence and bladder issues are defined as needing to pass urine more than 8 times per day, leakage of urine through cough, sneeze, urge, or without cause. It is important to seek help if you notice damp underwear, need to use pads because of leakage or are constantly running to the loo to pass urine.

There are many different types of incontinence with the main ones defined as stress incontinence, urge incontinence and voiding dysfunction/incomplete emptying. There is also mixed incontinence (mix of the 3 main ones) and also a term called overactive bladder syndrome which can be a mixture of all forms of incontinence. There are also inflammatory bladder conditions that cause incontinence such as bacterial cystitis and interstitial cystitis. Physical issues such as previous surgery, childbirth and prolapse can also cause incontinence too.

The first task for the clinician is to find out how severe the incontinence is, based on the frequency of leakage, whether the woman finds it necessary to use incontinence pads, and if so how many pads. Some patients may prefer to change their underwear more frequently, while others may tuck tissue paper inside their underwear, and just throw away the tissues whenever they are damp.

The classic feature of stress incontinence is that the patient leaks with coughing, sneezing, laughing, running, playing sport or lifting heavy objects

The classic feature of urge incontinence is that the patient rushes to the toilet with an urgent desire to pass urine, but as she gets to the loo and is taking down her trousers, the urine comes away from her- sometimes before she has even sat down. Unfortunately these patients cannot predict when these bladder spasms will come upon them, and therefore can’t really tell when they are likely to leak.

Nocturia is defined as being woken up by your bladder needing to go to the toilet- as opposed to being woken up by a crying baby, a snoring husband, or menopausal night sweats. However nocturia is age dependent. Nocturia is defined as waking 1 or more times per night if under 60 years of age

Typically this patient Voiding dysfunction/ Emptying difficulty has to strain to commence voiding (called “hesitancy”). She may also have observed that when she compares herself to other women urinating in the toilets at the movies or in airports, her stream seems poorer than others with the urine dribbling out more slowly. She will often also describe the sensation of incomplete emptying and may need to go back to the toilet within a relatively short time to re-void. Sometimes she will leak as she gets off the toilet, which is how she realises that she is not empty. This is called post-micturition dribble incontinence.

In males these symptoms most commonly occur when the prostate gland is enlarged- causing a relative urethral obstruction and making it more difficult for the urine to get out. These men have chronic high residual urine, so they end up going to the toilet very frequently in a vain attempt to empty out. They often dribble urine onto their clothes. When such men have prostatic surgery they usually find that their urine flow rate returns to normal and they usually stop dribbling.

We will also need to explore how inflammation of the urinary bladder leads to suprapubic pain, and consider the two main causes of this, Bacterial Cystitis and Interstitial Cystitis .It often feels difficult to treat incontinence in the presence of bacterial cystitis, because such patients are overwhelmed by frequency and urgency of micturition and they may experience disabling suprapubic pain. It is fixable with the right treatment though. It all gets back to who is managing you.

On the other hand, a separate cause of Urinary Pain, called Interstitial Cystitis, does not usually cause much incontinence at all- it just causes suprapubic (bladder) pain with severe frequency and urgency of micturition.

The overactive bladder (OAB) is a clinical syndrome, not a urodynamic diagnosis. It comprises frequency, urgency, and nocturia, with or without urge incontinence.

Gynaecological conditions such as Endometriosis and Adenomyosis etc can also cause issues with bladder and pelvic floor.

Please read my post on Atrophic vaginitis as this is also another cause of weakness in the pelvic floor and bladder and could be a cause of incontinence.

No matter what sort of incontinence you have, there is always an answer and a solution to your problem. Not all solutions are surgical either. More often than not some conservative treatments, some exercises and some acupuncture is all that is needed. Sometimes all some women need is some treatments with estrogen creams to help with tone in the vagina, bladder and pelvic floor

Surgery and now bionic devices are always an option for those whom have tried conservative options and aren’t getting the desired results. Surgery is often used because of quality of life issues. Again surgery these days is so effective and less invasive and the recovery is so much quicker due to keyhole surgery and new surgical interventions.

If you are experiencing incontinence or bladder issues, please book in and see me, or a good pelvic floor/urodynamic specialist, so you can be evaluated properly and see what is going on and implement the right treatment strategies to get your quality of life back again. Many times there may be an easy non-invasive treatment for your particular issues. Even when surgical intervention is needed, these days even this is less invasive than it used to be and the recovery and results are very quick.

Please read my post of Atrophic Vaginitis as well as this all ties into this area too, especially for those women in the menopause and post menopausal time of their life.

 

Regards

Dr Andrew Orr

Reproductive Medicine and Women’s Health Medicine Specialist

-No Stone Left Unturned

– Women’s & Men’s Health Advocate

Period Pain “IS NOT” Normal and Doctors in Australia and The Rest of The World Need to Start Listening

Millions of women around the world are told that period pain is normal and then go on to endure years of suffering and even infertility because it. Some women have endured so much pain and been “missed” and “dismissed” by so many healthcare professionals so many times that they have taken their own life because of it. It just should not happen and it needs to stop.

One of the major causes of period pain is Endometriosis, or its sister disease Adenomyosis. This crippling disease can cause period pain, pelvic pain, joint pain, pain with bowel movement, irriatbel bowel syndrome, pain with ovulation, swollen painful belly (known as endo belly), chronic fatigue, anaemia, heavy painful menstrual flow and can lead to infertility. Some women will quite literally not even be able to work due to debilitating symptoms of this disease.

It is estimated to affect 176 million worldwide and affect one in ten women, but that is only the ones diagnosed, so those figures are grossly understated. The facts around the disease are also grossly understated and poorly understood by many and why so many women are “missed” and “dismissed” by all the so called healthcare professionals they have seen. The other issue for a significant portion of women with the disease, is that they are asymptomatic (meaning no symptoms) and do not even know that have it. Many of them may never be diagnosed unless they are having problems falling pregnant, and even then many of them are not investigated properly to see if endometriosis is the cause of their long-term struggle to have a baby. It really is disgusting on so many levels. There is no other way to put it.

Of those one in ten women actually diagnosed many of them have taken up to ten years, or more, to be diagnosed and have their disease “missed” and been “dismissed” by multiple healthcare professional during their debilitating journey to find an answer for their sufferings. It is a nightmare of epic proportion for women world wide and the nightmare needs to end and healthcare professionals and everyone else needs to become educated and start listening to women and getting the message out there that “Period Pain IS NOT normal”.

So many women worldwide are suffering from period pain, pelvic pain, pain during sex, or infertility and endometriosis is the first thing that needs to be ruled out. Young women in particular have trouble convincing people they are having more than just bad period pain. So many young women (and older ones) are told just to “Suck it Up”, or “Deal with it”. Many mothers will even tell their daughters “This is just normal”, or “This is just what happens”, or “I have to put up with this, so you need to as well”, when in fact nothing could be further from the truth. Teenagers are not too young to have the disease and have it diagnosed and investigated either. Early intervention, diagnosis and management is crucial when it comes to endometriosis. The longer the disease is left, the harder it is to treat and manage, and left untreated can cause a woman years of debilitation and misery in every aspect of her life, years of surgery, years of pain killers and opiates, even after the best medical treatment. Healthcare providers and women around the world need to know that the longer it takes to diagnose, the longer the disease is there and the more damage it can do inside the body. Some women will have their lives crippled by not having early intervention. Some women have got to the point that they can no longer put up with the disease and being dismissed and have either attempted taking thier own life, or have succeeded in doing so. It is just so wrong that women get to this point.

The other issue that women face, once they are diagnosed, is that many of them end up seeing the wrong specialist to do their surgery. While most gynaecologists can do investigative surgery, many of them are ill-equipped to surgically remove the disease and actually do not specialise in the disease, or the excision of the disease properly. So many women have not seen the right specialist, who has not investigated and managed the disease properly and then left women to deal with the consequences of this inadequacy in their scope of practice. Women and healthcare providers need to be educated that women who potentially have endometriosis, or have a high likelihood of the disease, need to see an Advanced Trained Laparoscopic Surgeon, who has had extra specialised training in the excision of the disease and who has had extra specialised training in the management and treatment of the disease as well. Just because someone is a gynaecologist, or specialist, does not mean they are a specialist in the disease. This is also a huge misunderstanding when women require diagnosis and management of the disease and why so many are still left with crippling pain and symptoms, even after medical intervention. Quite simply, they have just seen the wrong person for the job and this also needs to be addressed in education and training around this disease.

This week the National Institute for Health and Care Excellence (NICE) in England has released the first ever guidance on managing this horrible disease that affects millions of women worldwide. They are hoping it will not only help GP’s and healthcare providers in the UK, but also GP’s and healthcare providers here and around the rest of the world too. NICE is calling for GP’s in Australia and the rest of the world to stop overlooking symptoms of this disease, such as bad period pain, so that women are not “missed” and “dismissed” for up to a decade or more. NICE are asking for endometriosis to be taken more seriously than it presently is and while that is starting happen here in Australia and the rest of the world, the changes have still been too slow. It really is just not good enough given that so many women are suffering from this debilitating disease worldwide.

One of my mottos is that “Period Pain IS NOT Normal” and I will continue to say this forever and a day and it is great to see national health care bodies like NICE actually backing that up and trying to get healthcare providers to do the same. While others are slow on the uptake, I will never stop in my quest to get women the help they need for this disease and will do my best to stop women being “missed” and “dismissed” and get them the help, care and attention they need and hopefully be a part of one day bringing an end to this debilitating disease.

Next week I will be in Sydney at a National Endometriosis Symposium shouting my message to healthcare practitioners as well. Let’s hope they finally start listening to the facts about endometriosis too. Let’s end the silence and get this information out there to everyone. If you do want to find out more about the facts about period pain and this disease, you can visit my webpage, or you can also visit Endometriosis Australia at www.endometriosisaustralia.org. I specialise in the treatment and management of this disease and want every woman on the planet to know that Period IS NOT Normal and that there is help out there.

 

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-“No Stone Left Unturned”

-“Period Pain IS NOT Normal”

 

 

Hysterectomy “DOES NOT” Cure Endometriosis

After my recent post about the misinformation people get told, I thought I would start with one of the biggest pieces of misinformation and one of the biggest lies in healthcare, women with endometriosis are told.

Many women are led to believe that hysterectomy is a cure for endometriosis and this is probably one of the most non-factual statements that many healthcare professionals are guilty of telling women. This is because they lack the understanding of the disease and lack knowledge of how the disease can spread to other areas of the body outside the uterus.

For the record, and this is fact, Hysterectomy DOES NOT cure, never has cured, and never will be a cure for endometriosis.

Most endometriosis is found outside the uterus and can be found in the pouch of douglas, utero-sacral ligaments, ovaries, intestine, pelvic wall, bladder and it can even spread up into the diaphragm, thoracic cavity, liver, pericardium, rectum and other parts of the body. It has even been found in the brain and distal joints such as the fingers.

All women with endometriosis need to know that endometriosis will still stay in the places mentioned above, irrespective if the uterus is removed, or not.

Many women will often comment that hysterectomy has cured their endometriosis and this is because they have been led to believe what their doctor has told them, they lack the understanding of the disease and they may have had some relief of pain usually associated with their menstrual cycle.

All hysterectomy will do for a woman with endometriosis is stop their menstrual cycle and any associated symptoms and pain associated with her menstrual cycle. Some women are also just lucky to become asymptomatic after hysterectomy too.

The type of hysterectomy may also help to slow the progression of the disease too. What many people do not understand it they there are two types of hysterectomy. One is a full hysterectomy, where the uterus and ovaries are removed and the other is a partial hysterectomy, where only the uterus is removed and the ovaries are left behind. It may be possible that a full hysterectomy, where the ovaries are removed, may in fact reduce some of the estrogen that is driving the disease and make someone asymptomatic.

The other gynaecological issue that many healthcare practitioners misdiagnose and overlook is Adenomyosis. Adenomyosis is an inflammatory disease deep within the wall, muscle and tissues of the uterus. Many now believe that Adenomyosis and endometriosis are one in the same disease, except Adenomyosis is deep within the muscles and tissues, where as endometriosis tends to be more superficial.

Removal of the uterus will in fact help Adenomyosis and help with the associated symptoms, such as heavy bleeding and pain. Many women actually have Endometriosis and Adenomyosis at the same time and many do not even know they have both diseases. Then when the uterus is removed, women experience less pain and symptoms, or no pain and symptoms, that was actually caused by the Adenomyosis rather than the endometriosis. Then these women are led to believe that they have been cured of endometriosis due to the resulting levels of pain and symptoms that are now gone. But, while their Adenomyosis may be cured (and I use this term loosely due to context), their endometriosis still remains. But if they are now asymptomatic, which many women are, they many not know that the endometriosis is actually still there. If you are one of these people I do need you to know that the hysterectomy has not cured your endometriosis at all and it is still there in your body. If a hysterectomy has cured your pain and associated symptoms is because of everything I have mentioned above. Again, hysterectomy DOES NOT cure endometriosis.

I also see the opposite of this in practice too. Many women whom have had a hysterectomy are still getting lots of abdominal pain, intestinal pain, bladder pain, rectal pain and others pains in the body. It is often hard for them to hear that their pain they are experiencing is actually from endometriosis, which they have been previously diagnosed with, yet believe has been cured due to the removal of the uterus and sometimes ovaries are well (partial, or full hysterectomy). The only way that many will actually fully believe you is after they have had further surgery and the disease is found and excised and their symptoms are stopped, or reduced. It is not until then, that these women will know what you have said to be true and that they have been sold the biggest lie on the planet.

The reason I wanted to speak about this is because I see so many women believing that hysterectomy (partial or full) will cure their endometriosis and have been sold the lie. Unfortunately many of these women are still suffering greatly and are often left wondering why, or are told it can’t be endometriosis as the uterus has been removed. It is so terrible to hear this and see this statement being spread as gospel by healthcare practitioners and even surgeons who know no better and do not understand endometriosis as a disease state. It is also hard to hear other women tell their fellow sisters the same lie, even though it is not really their fault and they actually do not know any better. I am writing this so the truth is out there and we get to stop this misinformation from spreading any further.

I hope this has helped you with getting some of the facts and see why so many women are told the one of the biggest lies in healthcare.

Oh and remember one more thing….  Period Pain IS NOT Normal, no matter what anyone tells you!

 

Take care

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Medicine Specialist)

Women’s and Men’s Health Crusader

-“The International Baby Maker”

-“No Stone Left Unturned”

 

 

 

 

 

 

 

 

Atrophic Vaginitis

Atrophic Vaginitis

Atrophic vaginitis is a vaginal disorder that usually happens after menopause. When estrogen levels fall, the vaginal walls can become thin, dry, and inflamed. This then causes the surrounding tissue to lose its elasticity and become atrophied. This can be uncomfortable. Gynaecological conditions such as endometriosis, adenomyosis and fibroids can make someone more prone to atrophic vaginitis as well.

As many as 40% of postmenopausal women experience symptoms of atrophic vaginitis after menopause, but only 20 to 25 percent will seek medical help. Many women will not seek treatment because they feel embarrassed due to the sensitive nature of the condition. Some women just put up with it believing it is normal. Untreated, it can affect a woman’s quality of life and even lead to increased risk of prolapse and other gynaecological and urological conditions. Many of the treatments are non-invasive and are very effective in a short amount of time.

Symptoms of Atrophic Vaginitis

  • vaginal dryness
  • pain during sexual intercourse, or dyspareunia
  • thin, watery, yellow or gray discharge
  • paleness and thinning of the labia and vagina
  • irritation when wearing certain clothes, such as tight jeans, or when on a bike seat
  • more frequent urinary tract infections (UTIs), or urinary tract like infections(which is from inflammation, with no infection present)
  • Vaginal Prolapse

Symptoms can also present in issues with the bladder and urination

  • painful urination
  • blood in the urine
  • increased frequency of urination
  • incontinence
  • increased likelihood and occurrence of infections, or irritation to the bladder that may feel like an infection

There may also be a reduction in pubic hair, and the vagina may become narrower and less elastic, which may cause a condition called vaginismus.

Causes

During perimenopause, menopause and post-menopause, a woman can have decreased levels of estrogen. When the ovaries stop making estrogen after menopause, the walls of the vagina become thin, and vaginal secretions are reduced. Similar changes can happen to women after childbirth, but these changes are temporary and less severe. These same changes can happen for women with endometriosis and adenomyosis and often why there can be changes to the wall of the vagina. Some of the medications used to help these conditions can also cause thinning of the vaginal wall and surrounding area. Many women with endometriosis, adenomyosis, fibroids etc, will have increased risk of atrophic vaginitis during the perimenopause, menopause and post-menopausal period.

Medications, or hormones, can be used as part of the treatment for breast cancer, endometriosis, adenomyosis, fibroids, or infertility to reduce estrogen levels. This decrease in estrogen can lead to atrophic vaginitis.

Other causes of atrophic vaginitis include:

  • severe stress
  • depression
  • Surgery, or treatment to the pelvic area
  • uncontrolled diabetes
  • rigorous exercise
  • chemotherapy

Other substances that can cause further irritation to the vagina are:

  • smoking
  • soaps
  • laundry detergents
  • lotions
  • perfumes
  • douches
  • tampons
  • yeast infections
  • condoms (due to latex allergy)

Diagnosis

The best person to see for this condition is a pelvic floor/urodynamic specialist, or a women’s health specialist. While you GP can help with diagnosis of this condition, it is preferable to see a specialist who has more training in this condition and can help manage this moving forward. A specialist will carry out proper examinations, be able to diagnose this correctly and ask about medical history. They may ask about the use of agents that can irritate the area and cause or aggravate symptoms, such as soaps or perfumes.

Your specialist will also do tests to rule out STI’s and other possible causes of infections such candidiasis, bacterial vaginosis etc. Atrophic vaginitis can make the area more susceptible to becoming infected. It can occur alongside an infection. A diabetes test may be performed to rule out diabetes. A biopsy may be taken to rule out cancer.

Treatment

The first line treatment is usually conservative treatments with topical estrogen creams inserted into the vagina and focuses treatment on the affected area. A low-dose estrogen cream can be used to stimulate rapid reproduction and repair of the vaginal wall, tissue and cells. Women should be shown how to insert the creams with an applicator and then use their finger to help disperse the cream properly to get good coverage of the vaginal wall.

Creams are much better than pessaries, because pessaries often do not disperse well and may only give coverage to a small area. These creams are also safe to use for those at risk of certain cancers, or who have had hormone dependent tumors.

Some women may also need to take Hormone Replacement Therapy (HRT), in the form of a tablet, gel, patch, or implant to supply estrogen to the whole body. These estrogens are effective, but there may be side effects. Patients should discuss the risks of long-term HRT (especially breast cancer risk) with their healthcare practitioner.

Some women may also need to use a water-soluble vaginal lubricant may help to provide relief during intercourse, for mild cases.

Regular exercise is important, as it keeps blood flow and genital circulation high. Pilates and yoga is very beneficial for the pelvic floor and core stability and should be part of a woman’s overall lifestyle management. Women in the perimenopause and menopausal periods of their life should be doing some form of weight baring and strengthening exercise regularly.

Diet is also important and very effective in the overall treatment of atrophic vaginitis, menopause and gynaecological conditions. A low GI/Low Inflammatory based diet should be adopted and it is important to see a qualified nutritionist to help set out the right individualized diet for you.

There are also herbal medicines, supplements, omega 3 oils, and other natural based formulas that can help with atrophic vaginitis. Acupuncture and Chinese herbal medicine are very effective in helping with atrophic vaginitis, menopause and gynaecological issues such as endometriosis and adenomyosis. There are many natural medicines and natural treatments that can help with pain, hormone regulation and micro-circulation for the vagina, uterus, bladder and reproductive organs.

Prevention

Regular sexual activity and stimulation of circulation to the vagina can help prevent atrophic vaginitis. It is more around climax helping, rather than just sexual activity, or intercourse. Some women have pain during intercourse, or experience dryness, so foreplay and being well lubricated can help this. Using a water-soluble vaginal lubricant can soothe mild cases during sexual intercourse. Masturbation and stimulation without intercourse to produce climax may help those women who have pain with intercourse, or who may not have a partner.

Regular climax and sexual activity can also show benefits for both the elasticity and flexibility of the region. Women who have regular climax and are sexually active report fewer symptoms of atrophic vaginitis when compared to women who do not regularly climax, or have regular sexual intercourse.

Regular exercise, such as Pilates and Yoga can help with the pelvic floor, vaginal tone, bladder and reproductive organs.

A low GI/Low Inflammatory based diet should be adopted and it is important to see a qualified nutritionist to help set out the right individualized diet for you.

There are also herbal medicines, supplements, omega 3 oils, and other natural based formulas that can help with the prevention of atrophic vaginitis and assist with circulation and hormone regulation.

Fast facts on atrophic vaginitis

  • Atrophic vaginitis refers to dryness of the vagina.
  • Symptoms include painful intercourse and an increase in urinary tract infections (UTIs), or urinary tract like infections (due to inflammation of the bladder, not from infection).
  • It is caused by a reduction in estrogen, normally following menopause or treatment with anti-estrogen drugs. It can also be caused from gynaecological conditions such as endometriosis, adenomyosis and fibroids.
  • Topical treatments and hormone replacement therapy (HRT) may help relieve symptoms
  • Around 40 percent of postmenopausal women experience symptoms of atrophic vaginitis, but many do not seek treatment.

If you you need help with any of the symptoms mentioned above, please book in to see me for a consultation and management. If you cant see me, please get your healthcare practitioner to refer you to a specialist for diagnosis, treatment and management of this condition and its symptoms

Take care

Regards

Dr Andrew Orr

Reproductive Medicine & Women’s Health Medicine Specialist

-“The International Baby Maker”

-“No Stone Left Unturned”

 

The Facts About Period Pain & Endometriosis- “What Women Need To Know”

The Facts About Period Pain & Endometriosis

-“Why some of the things I hear women get told gets me angry sometimes”

After my recent post on endometriosis and sharing what “Endo Belly” is,  I have to say that I think hearing your stories has got me even more fired up. Not because of your stories, these I like hearing ( if you know what I mean), but because so many of you have been ‘dismissed’ and had so much ‘missed’ over the years.

Many of you have also been told utter BS (bullshit… sorry for swearing) and it just gets me so upset to hear this BS continue in both the public arena, closed groups and by other healthcare professionals. When are women going to get the support they need and get the health system to start listening.

Today I was talking to a couple about this very topic and was explaining to the this young lady’s partner that if guys had pain in their testicles daily and couldn’t walk, were curled up on the bedroom floor, had vomiting from the pain, had to ingest copious amounts of pain killers etc to just function, then governments would rewrite the health system, laws would be made, research would be done and those testicles would endure pain no longer. Well.. that is what I think anyway.

The biggest problem for women is that many of you believe that period pain is normal, because that is what you have been led to believe. Then healthcare professionals reinforce it and you are basically made out to be neurotic when you try and tell anyone that you can’t handle it any longer. Suck it up they say. Take some painkillers they say. Have a baby they say. Take the pill they say. There are so many BS things said to you all and all of them are wrong. There are so many other things wrong with everything from support groups sprouting misinformation, GP’s telling people misinformation, specialists telling people misinformation and people now relying on “Dr Google” as the gospel for their healthcare diagnosis. This is where the problem all starts and in many ways ends.

So how do we fix this?

Well, education is the first step. This is not just to the public, but to healthcare professionals as well. We also need to start educating women at a young age that “Period Pain IS NOT normal” and neither are other menstrual irregularities that could be the signs of other gynaecological conditions. Early intervention and treatments and management it always going to be the key to any disease state. Thousands of years ago in China, the Yellow Emperor had a classic saying “To treat a disease once it has already started and been expressed in to the body is like trying to forge arms once a war has already started, or trying to dig a well once one if already thirsty”.

Trying to treat any disease once it has been expressed is hard work and for some diseases, nearly impossible. Prevention is the key and like any disease, we need to find ways of preventing endometriosis too. But if the disease is expressed, we need proper education to know the signs, know the symptoms and get early intervention and treatments and management as soon as possible.

Endometriosis can be managed, just like any other disease. I have asthma and I am symptom free because I manage it properly and have the training and education and proper treatments to manage it. I still have the disease, but I have learnt to manage it and be symptoms free. The same can be for endometriosis if you see the right people and get the right treatment.

But, finding these people is hard and we also need people to listen and do the treatment too. We do need people to take some ownership in there health too. I mean this is a caring way when I say this. Having had a debilitating and life threatening disease I know how hard it can be just to function, both physically and emotionally. I also know hard it was for me to find the right people to help me too. So I get it. But we still need to talk about this and be honest about ownership too. Please don’t buy into the diagnosis and the label if you know what I mean. Doing that can eat you up, make you angry/mad and then makes things worse. I know because I have been there. I now teach people to rise up, ditch the label and be the best they can be daily. But, it can be hard work, as many of you know. I get it.

So, lets start with looking at the facts around Endometriosis first and in the next lots of posts I’ll talk about the management and treatments to get women their lives back

The Facts about Endometriosis

1. Period Pain IS NOT Normal- You are not meant to get period pain. Some slight heaviness, or mild discomfort maybe, but pain you should not get at all. Pain is not normal and we need to stop saying it is.

2. A significant portion of women with Endometriosis are asymptomatic– A significant portion of women DO NOT get pain, or any symptoms at all. Just because you do not have pain, does not mean you do not have endometriosis.

3. Symptoms DO NOT correlate to the extent of the disease– As mentioned previously, some women with relatively small amounts of endometriosis will have significant pain, have lots of symptoms, while some women who are riddled with it may have no symptoms at all. This is why i do not like the staging system (1-4) because it really does not accurately describe a women’s symptoms, or have it correlate to the extent of the disease.

4. The only way to diagnose Endometriosis definitely is via surgical intervention– Scans, blood tests etc do not diagnose endometriosis. You cannot have a scan to diagnose endometriosis and you cannot have a blood test to diagnose endometriosis. The definitive diagnose IS and ALWAYS WILL BE via a laparoscopy/laparotomy, along with a biopsy and tissue taken to examine. A laparoscopy is the goal standard investigation of examining the pelvis and for investigating gynaecological disorders such as endometriosis. The laparoscopy also need to be done by what we call an Advanced Trained Laparoscopic Surgeon, who has extra years of surgical training, and who specialises in this disease and specialises in the excision of endometriosis. It can’t just be done by a regular gynaecologist and this is where many go wrong. They just haven’t seen the right surgeon first up who has he proper skills to deal with it effectively. The first surgery should always be your best surgery and early intervention and management of this disease is crucial. The longer it is there, the worse it can become. But, please know that surgery does not cure endometriosis. It is just the first stage in the management of the disease and endometriosis needs ongoing care and a multimodality approach to treat if  effectively. It needs a team to manage it properly.

5. There is NO cure for Endometriosis– At present there is no cure for endometriosis. Just as I mention my asthma before and it having no cure, the same applies to endometriosis. Once it is expressed into the body, it will always be there. Even if someone becomes asymptomatic, the disease it still there. But while there is no cure, the disease can be managed and women can become asymptomatic with the right help, right treatments and right management. I see this is practice daily.

6. Having a baby will not cure endometriosis– Many women are told to go away and fall pregnant and have a baby as this will fix their period pain and cure their endometriosis. This is a load of rubbish. Having a baby will not cure endometriosis. It may stop you having period pain for 9-10 months because you won’t be getting your menses, but you can still get other symptomatic pains and referral pains etc. Pregnancy does not fix endometriosis. The reason why women are told to go and have a family as soon as possible is because endometriosis can make it harder to fall pregnant, for some people.

7. Endometriosis may cause Infertility– While it may make it hard to fall pregnant for some women, other women with it may have no trouble falling at all. But women do need to be educated that it could affect your fertility and one of the major reasons women end up seeking help for fertility services.

8. Endometriosis is Estrogen Driven, Not caused by Estrogen dominance– Estrogens do drive endometriosis. This could be from oestrogen’s in our diet, in our environment, from hormones, drugs, plastics, abdominal fats, body fats and any small amounts of circulating oestrogen’s. Estrogens do not have to be in excess, or be dominant to drive endometriosis.

9. The Pill, or Contraceptives DO NOT fix endometriosis– While the pill and contraceptives can help with hormonal regulate and in some cases even stop the period, they do not fix endometriosis. In many cases the Combined pill can actually make it worse because of the oestrogen’s in it. Plus it then masks the symptoms of endometriosis and then when a woman comes off it, the endo is still there and for some women it could lead to them being infertile. The pill masks endometriosis and many other gynaecological issues. It does not fix them

10. You can have Endometriosis at a Young, or Older Age– Endometriosis does not discriminate age. Young girls can have it and older ladies can have it also. It can present at almost any age once the menses has started and can continue even when the menses has stopped. The symptoms may get less with menopause though.

11. Hysterectomy does not cure endometriosis– Hysterectomy does not fix endometriosis because many times endometriosis is not in, or on, the uterus and it can present anywhere in the body. It has been found in the joints, in the brain, around the heart, on the retina of the eyes, around the bowel and in nearly every part of the body. So removing the uterus does not cure endometriosis in many cases.

12. Endometriosis requires a multi modality approach– Like many diseases we all face, there is never one particular miracle cure, or miracle treatment for endometriosis. It requires a multi modality approach of surgery, proper diet, lifestyle management, counsellors, hormones, herbal medicines, acupuncture, physio therapy, plaits, exercise, pain killers, vitamins etc. This is how you diagnose, treat and manage endometriosis properly

13. Endometriosis IS NOT an autoimmune disease– Endometriosis is not an autoimmune disease. It is an autoimmune like disease because it is made worse by inflammation in the body, but it cannot be classed as an autoimmune disease.

14. There Are Hereditary and Genetic links– While we do not know the exact cause of endometeriosis, we do know that it does run in families and it there is genetic and hereditary links.

15. Endometriosis can cause many other issues in the body– Like any inflammatory disease, endometriosis can cause issues with moods, interfere with hormones, disturb sleep, cause fatigue, cause depression, exacerbate mood disorders, cause muscular pain, cause skeletal pain, have pain refer down your legs, make your joints ache, cause bowel movements to be difficult, cause loose bowels and IBS like symptoms, cause UTI like symptoms, cause bladder pain, nocturnal urination, pain with sex, pain and bleeding with exercise, ovulation pain and so many other symptoms not mentioned. It can cause many issues both physically and emotionally and people need to be aware of this. Some women are at the point of suicide and recently we have seen women take their lives, because they just have not been listened to and it has all become too much.

There is probably a few more things I need to add in here. Please feel free to add comments to add in more. But, this is a start and hopefully people can learn from this and we can start educating people on the facts around this horrible disease. Please know there is always help.

Please know the disease can be managed with the right people on board helping you. Please know there are some really good support groups like Endometriosis Australia out there.

Please know there are some amazing women ( and men like me) out there trying to be your voice and get people to listen. Hopefully one day we will get a cure and women will get the treatment and management of this disease that they so desperately deserve. Sorry for the long post. But we need to get this out there.

Take care amazing people. Keep your chins up and know that there are people who will listen too.

If you do need help with period pain, or endometriosis, please book in a consultation with me. I do see people from all over the world.

Regards
Dr Andrew Orr

Women’s Health Consultations

Women’s Health Consultations

*Are you sick of Painful Periods?
*Are you getting pain with sex?
*Is your period irregular and messing with your life?
*Are you getting bad acne?
*Are you getting increased bladder frequency?
*Are you getting some incontinence with exercise?
*Are you sick of having to put up with mood swings and hormone imbalance?
*Sick of healthcare professionals and friends telling you that your symptoms are normal?
 
Many of these issues are not normal, but more importantly many of these issues can easily be treated quite easily with the proper investigations, treatments and proper management. 
 
Everyday I see women who are sick of being ‘missed’ and ‘dismissed’ by everyone they see and they just want to get some sort of normal life back. This is where as a Reproductive Medicine and Women’s Health Specialist, with over 20 years experience with fertility, pregnancy and women’s health, I can really help. My motto is “No Stone Left Unturned” and I apply this to every person I have helped.
 
I am proud to announce that I now have a better way of being able to doing consultations for anyone needing help with gynaecology, fertility and other health issues. It doesn’t matter where you live, now I can help more people from around the globe and get them the answers they should be getting. 
 
Before we only had skype, which had limitations of not being able to screen share the important information that I need to share in a consultation with patients
 
Well, now I can do consultations through Zoom and these are nearly the same as if you were with me in person and share the same information, just the same as if you were in person.
 
Reports and Treatment medicinals and supplements are then mailed to you.
 
This is for patients who live out of the Brisbane area, or are interstate and overseas and it gives so much more scope to help everyone who wants my help.
 
If you want to get the best advice, best care and see someone with over 20 years experience in helping people, who is a Reproductive Medicine and Women’s Health Specialist (medical) as well as having qualifications in complementary medicine, then you need to see book in with me.
 
My multi-modality approach has helped over 12,500 plus babies into the world and helped tens of thousands of women with women’s health issues and gynaecological conditions such as Endometriosis, Adenomyosis, PCOS, Fibroids, Bladder & Bowel Issues, Pelvic floor stability, Thrush, Migraines, Hormone Imbalance and so much more. I can help with all Women’s Health and Reproductive issues.
 
As a Baby Maker and Women’s Health expert my motto is “No Stone Left Unturned” and I apply that to every person I help. It is because I care and want to help care for you as well.
 
If you would like to organise an online, or in-person consultation with me, please give my staff a call on +61 7 32795697, or email info@shentherapies.com.au. You can also submit an online enquiry through my website www.drandreworr.com.au too.
 
I hope to be able to help you and care for you all soon
 
Regards
Dr Andrew Orr
Reproductive Medicine & Women’s Health Specialist
-No Stone Left Unturned
“The International Baby Maker & Women’s and Men’s Health Advocate”

Exciting New Online Consultations

Exciting New Online Consultations

*Are you sick of Painful Periods?
*Are you getting pain with sex?
*Is your period irregular and messing with your life?
*Are you getting bad acne?
*Are you getting increased bladder frequency?
*Are you getting some incontinence with exercise?
*Are you sick of having to put up with mood swings and hormone imbalance?
*Sick of healthcare professionals and friends telling you that your symptoms are normal?
 
Many of these issues are not normal, but more importantly many of these issues can easily be treated quite easily with the proper investigations, treatments and proper management. 
 
Everyday I see women who are sick of being ‘missed’ and ‘dismissed’ by everyone they see and they just want to get some sort of normal life back. This is where as a Reproductive Medicine and Women’s Health Specialist, with over 20 years experience with fertility, pregnancy and women’s health, I can really help. My motto is “No Stone Left Unturned” and I apply this to every person I have helped.
 
I am proud to announce that I now have a better way of being able to doing consultations for anyone needing help with gynaecology, fertility and other health issues. It doesn’t matter where you live, now I can help more people from around the globe and get them the answers they should be getting. 
 
Before we only had skype, which had limitations of not being able to screen share the important information that I need to share in a consultation with patients
 
Well, now I can do consultations through Zoom and these are nearly the same as if you were with me in person and share the same information, just the same as if you were in person.
 
Reports and Treatment medicinals and supplements are then mailed to you.
 
This is for patients who live out of the Brisbane area, or are interstate and overseas and it gives so much more scope to help everyone who wants my help.
 
If you want to get the best advice, best care and see someone with over 20 years experience in helping people, who is a Reproductive Medicine and Women’s Health Specialist (medical) as well as having qualifications in complementary medicine, then you need to see book in with me.
 
My multi-modality approach has helped over 12,500 plus babies into the world and helped tens of thousands of women with women’s health issues and gynaecological conditions such as Endometriosis, Adenomyosis, PCOS, Fibroids, Bladder & Bowel Issues, Pelvic floor stability, Thrush, Migraines, Hormone Imbalance and so much more. I can help with all Women’s Health and Reproductive issues.
 
As a Baby Maker and Women’s Health expert my motto is “No Stone Left Unturned” and I apply that to every person I help. It is because I care and want to help care for you as well.
 
If you would like to organise an online, or in-person consultation with me, please give my staff a call on +61 7 32795697, or email info@shentherapies.com.au. You can also submit an online enquiry through my website www.drandreworr.com.au too.
 
I hope to be able to help you and care for you all soon
 
Regards
Dr Andrew Orr
Reproductive Medicine & Women’s Health Specialist
-No Stone Left Unturned
“The International Baby Maker & Women’s and Men’s Health Advocate”

Endometriosis Awareness- Ending The Silence

Endometriosis Awareness

This month is Endometriosis awareness month and I have been invited to be a guest speaker for Endometriosis Australia and their endometriosis awareness campaign called “Ending the Silence.” Our aim is to bring awareness about this disease that is often overlooked. It is an issue myself as an endometriosis expert feels very passionately about. I treat women suffering from this disease every day and I hope that one day, endometriosis can be a word of the past.

Through awareness and education, let’s try and get women the early intervention and help they need sooner, rather than later.

What is Endometriosis
Endometriosis, which is an inflammatory gynaecological disease, by which endometrial like tissue grows outside the endometrium. It can spread outside the endometrium into the pelvis, bowel and intestines. It has even been known to get into the brain, joints and around the heart.This disease affects 1 in 10 women, often causing immense pain for them.

According to the Royal College of Obstetricians and Gynaecologist Guidelines for the Management of Endometriosis, it can cause the following symptoms:

Heavy Menstrual Bleeding
Period Pain
Pain with sex
Ovulation Pain
Irritable bowel like symptoms
Bladder issues
Chronic fatigue
Pain with bowel movement

The disease can also cause other symptoms such as :

Bloated belly that looks pregnant around your period (known as endo belly)

Bloated belly that looks pregnant and you are told it is from certain foods, but it isn’t, or may be a combination of food and inflammation from endometriosis (also known as endo belly)

UTI like symptoms that aren’t a UTI

Bleeding from the bowel with your period

Low Iron with no explanation

Being told you have IBS, but you don’t have IBS

Migraines/Headaches that are worse around your period

Irrational mood swings

There are so many other symptoms that could also be pointers to endometriosis.

This disease can also play major havoc with hormones and the libido. Many women with can have pain on intercourse which further lessens the desire around sex.
Women with endometriosis often have painful periods and can’t get out of bed, so if you experience this, there is a good chance that you actually have it.
Women with endometriosis can also have other hormonal disturbances such as mood swings, fatigue, restlessness etc. They can also have other symptoms such as migraines, headaches, dizziness, constipation, pain with bowel movements, joint pains and all manner of symptoms created from the inflammation that endometriosis is caused by and also creates

How Many Women Suffer from Endometriosis?
Endometriosis has now reached an all time high in its ever-growing presence. While the current research says that 1 in 10 women are affected by endometriosis, as an endometriosis expert, I believe, as do many others, that these figures may be grossly under exaggerated. Research also shows that a significant portion of women affected with endometriosis are asymptomatic (no symptoms) and may only ever get diagnosed if they are having issues with having a baby, or they may never be diagnosed at all. In addition to this, many women diagnosed with Irritable Bowel Syndrome actually have endometriosis and not IBS.

Many women have also been told period pain is normal and hence many never seek help for a condition that can be debilitating on their life and those around them. Women who suffer period pain and other menstrual related symptoms caused by endometriosis are often ‘missed’ and ‘dismissed’ by multiple healthcare professionals and it can take up to 12 years from onset of symptoms to a definitive diagnosis being made. Women with period pain caused by endometriosis have to live a life of pain, trauma and physical and emotional torment. Many of these women are barely getting through a day, let alone a whole month of exhausting symptoms related to this disease. Some sadly even turn to suicide.

The Western Medicine Approach on the Causation and Treatment of Endometriosis
To date, Western medicine does not know how or even why it occurs. The only solution that has been offered in the past was to laser it. This usually has a recurrence rate of up to 80%. Recently many doctors have been treating this disease by excising (cutting it out), which offers better relief with less recurrence. I do need to stress that when a surgeon is needed, it needs to be done by an advanced trained laparoscopic surgeon, who has had extra specialised training, and is an expert in endometriosis excision and management, and is not just any gynaecologist. This is where many go wrong and haven’t had the disease treated properly.

Despite the increased success in treating endometriosis through a surgical procedure, it still usually recurs in a majority of women.

So why isn’t the medical option alone working?

Primarily it is because they are just treating the symptoms and not the cause. You can take away most physical symptoms very easily, but if the real cause isn’t addressed at the same time, you have no chance of a full recovery. This includes emotional factors. In addition, many of the hormones that women are put on after surgery, mask the problem and can actually make it worse. By actually stopping the period, like many of these hormones do, there is an increased risk of further endometriosis growing. Sure, while you have no period, you have no pain or symptoms, but internally it is still there waiting to flare up again. Oral contraceptive pills containing estrogen must be avoided as they only add to making the problem worse. Progesterone only options should be looked at rather than a combined pill, if using hormones. These treatments also have limitations that include side effects in some women and contraceptive action for women desiring to conceive.

The Traditional Chinese Medicine Approach on the Causation & Treatment of Endometriosis
Firstly, I can only pass on what the Chinese have known and studied for 10,000 or more years, much longer than western medicine. They had the body and its internal organs mapped out longer before medical science in the west did.
In Chinese Medicine, they believe the liver governs the menstrual cycle, and that it also governs our emotions.They believe that through poor diet, lifestyle, medicines, environment etc, that these can then cause disruption to an organ in the body. Emotions such as anger, frustration, resentment, stress, irritability etc, can also cause the liver to be in disharmony. In Western Medicine terms, we know that poor diet and emotional factors can unlock predisposed hereditary issues, or dispositions through DNA recoding. Yes, diet can affect your DNA coding and so can emotional issues. Similarly we can reverse some disease states, and reprogram DNA coding through a healthy diet and fixing our emotional health.

When the liver is in disharmony, the Chinese believe it can cause blockages in our system. Western medicine now also believes that emotions can cause physical symptoms and we often see this is psychiatric, or body-mind medicine. These blockages then cause what we call stagnation. The Chinese believe that when the Qi (energy) becomes stagnant, it causes what they call Liver Qi Stagnation, and this is the cause of many gynaecological conditions such as endometriosis and PMS. As the Qi stagnation is left long term, it then affects the blood and turns it stagnant too. Imagine damming a river and the longer the water sits, the more stagnant it becomes because it no longer flows. This is where the Liver Blood Stagnation comes from and what they believe endometriosis is manifested from. When we look at endometriosis, it does present as blood clotting and pain. Basically it is like a varicose vein that has all that old, stagnant blood in it. The circulation is no longer moving and the blood now turns dark and causes pain.

Chinese medicine believes that not only is diet and herbal medicine needed to move the stagnant blood and help prevent the disease coming back, it also believes that the emotional component behind it also needs to be addressed. In Chinese medicine they use lots of warming and blood thinning herbs that are also anti-coagulants, but are also anti-spasmotics. The Chinese medicine also has herbs to help the liver function and also help with emotional wellbeing.

Chinese VS Western Medicine
The only difference between Chinese Medicine and Western medicine is the treatment principles. Chinese medicine looks at treating the cause of the issue, which means the symptoms get sorted by addressing the cause. Western medicine only treats symptomatically and therefore the cause of the issue is often not treated. That huge difference is why Chinese Medicine does get such great results. But like anything, it also depends on who you see and their experience in that field. But, I must stress that both medicines are equally as important and both are needed to get the best results possible. It is about a team effort and using a multi modality approach. It is also about finding your right team too. I will talk about this now.

Dr Andrew Orr’s Recommended Approach to Treating Endometriosis
Endometriosis has a highly variable disease state, and thus a multi-modality approach is needed to treat it. Targeting different pathways is likely to be important to move toward precision health (personalized medicine) in endometriosis. People with endometriosis need a team of people looking after them, not just one person and one approach.
For severe cases you will need to see a good advanced laparoscopic surgeon to get as much of the endometriosis excised (cut out-not lasered). Surgery is a much needed option if the pain is severe because it helps get rid of the endometriosis that can be seen. However, it does not deal with the microscopic implants of endometriosis that can’t be seen, and this is why endometriosis is likely to occur again. This is where the Chinese Medicine can help. You then use the Chinese medicine to treat the microscopic implants of endometriosis and stop it progressing further and therefore treat the cause. This will be the primary treatment after surgery and help stop it from recurring. This can be done along side medical hormone treatments as well.

Following the correct diet can also aid this healing process. The modern Western diet consists of many foods with high GI levels, causing inflammation to the body and therefore fueling conditions such as endometriosis. There are all sorts of diets out there attesting to be the cure for endometriosis, but half are them are actually making it worse. Unless the diet is about reducing grains, high GI carbs, sugars, and increasing proteins, then it isn’t going to help endometriosis.

Lastly, see a good counsellor. Acupuncture and Chinese medicine will help both the physical & emotional side, but sometimes solution-based talk therapy is needed for the best results. I provide clients with a list of preferred gynaecologists and counsellors within my appointments with them.

To support my view on the treatment of endometriosis, the Royal College of Obstetricians and Gynaecologists guidelines for treating endometriosis now states that Acupuncture and Chinese Herbal Medicine is a recommended therapy. A multi modality approach really can help, but for anything to work more effectively, you too, have to make a commitment. It is also about finding your team and the team of people right for you too.

Who I am and Why this Means so Much to Me
I am a Reproductive Medicine and Women’s Health Specialist, and an Endometriosis Expert with over 20 years of experience in Women’s Health Medicine and treating and managing endometriosis. I know all too well the trials and tribulations women have to go through before someone actually listens and gives these poor women a proper diagnosis. I also have loved ones with this disease and have also lived with a chronic painful disease too. While I may not fully understand and feel what women with endometriosis actually goes through, I do know what it is like to live daily life with a painful chronic inflammatory disease that can rule your life on every level.

The one thing I do want all women to know is that “Period pain IS NOT normal” and all too often women are told that period pain is normal. Nothing could be further from the truth. We need to educate women and young girls that period pain is not normal.

I have a motto of “Leaving No Stone Left Unturned” and I apply this to every patient I see with period pain, and those potentially suffering from endometriosis. I would like to see better education and awareness for the general public, but I would also like better education and awareness for healthcare professionals. I would like to see all healthcare professional use my motto and make sure that no woman is ever missed, or is dismissed with this horrible disease ever again.

I would like to conclude with one last message “ Women need to know that period pain IS NOT normal and that early detection and early intervention and treatment is the key to treating any disease properly.”

Lets end the silence about this horrible disease. Please support Endometriosis Awareness and this month please support Endometriosis Australia with their High Teas to promote endometriosis awareness. These High Teas will be run nationally on March 25th and in every capital city and some smaller cities also. Please see the Endometriosis Australia website for details (www.endometriosisaustralia.org)

Regards

Dr Andrew Orr

The Brisbane Baby Maker, Endometriosis Expert and Women’s Health Crusader

“Leaving no Stone Unturned”

“Period Pain IS NOT normal”

Time to Set The Records Straight about Endometriosis, Period Pain & Other Gynaecological Issues.

There are so many misperceptions and wrong information out there about period pain and gynaecological conditions that cause period pain and it really gets annoying hearing people get told the wrong information and false information. It is time we get people the help they need and stop people having gynaecological conditions missed and being dismissed also.

So lets set the records straight

  1. Period pain is not normal, no matter what you have been told, or who has told you this.
  1. Period pain is often the sign of gynaecological conditions such as endometriosis, adenomyosis or other gynaecological issue. It could also be a sign of something more sinister.
  1. Women who have endometriosis can also be asymptomatic (meaning no symptoms) so because you do not have pain, does not mean that you do not have it.
  1. With endometriosis, symptoms do not always correlate to the extent of the disease. Some women have only small visual pockets of it and this can cause extreme pain and inflammation, while women whom are riddled with it may have little, or no pain at all. It is not about the amount of the disease when it comes to pain profiles and classifications around pain and disease management. The classification system and grading system is just for a surgeons reference only and to gauge how much was found.
  1. Scans and blood tests cannot diagnose endometriosis. There are some specialised scans that can diagnose deep infiltrating endometriosis only, but even then, they are not 100% accurate, or a definitive diagnosis. There are very few people trained in this form of ultrasound too. Most women with endometrosis have the superficial disease, which cannot be diagnosed with specialised ultrasound , or normal ultrasound at all. Blood tests will definitely not diagnose endometriosis, or many other gynaecological issues either.
  1. The definitive diagnosis for endometriosis and other pelvic pathology is a Laparoscopy ( usually combined with hysteroscopy and dye studies) combined with histology (tissue from a biopsy). At the time of laparoscopy the visual disease is usually tidied up and removed at the same time, along with any adhesions and other pelvic pathology found.
  1. Not all gynaecologists, or surgeons can perform proper surgery needed for the removal of endometriosis. This requires an advanced laparoscopic surgeon to do this kind of work and not every gynaecologist, or surgeon has these skills. Many gynaecologists have very limited surgical skills when it comes to major gynaecological issues such as endometriosis. Just because someone has had surgery before, doesn’t mean they have had someone specialised to deal with the disease properly. This is a big mistake many people do not realise. You also always need to ask if the surgeon has advanced laparoscopic training and they excise (cut out) the disease, not burn it. You also need to ask their experience in treating and managing the disease state that you have been diagnosed with, or suspected of having. Some endometriosis may be so widespread it may need multiple surgeons, such as bowels surgeons, and in some cases it may need a gynaecological oncologist who can excise very fine parameters because of their training of cancer removal. Many women think they have had the disease removed when in fact their surgeon was unable to fully remove all the disease because it was out of their scope of practice.
  1. Teenagers are not too young to have endometriosis, or other gynaecological conditions. Early intervention and management of the disease is crucial and should not be left until later in life under any circumstances. Please do not let teenagers put up with period pain and have someone tell them it is normal.
  1. Surgery does not cure endometriosis. But it does help to control the spread of the disease and the inflammation because of the disease.Surgery can offer great relief from pain symptoms though. But the real treatment comes from trying to suppress the regrowth of the disease and microscopic implants (not visible to the eye via surgery) post surgery and this is what I do in my treatments.
  1. Pregnancy does not cure endometriosis, or period pain. In many cases, it can make it slightly better for a while, but most of this is due to women not having their period for an extended amount of time. It does not cure endometriosis and this is a widely spread myth that needs to be corrected
  1. Endometriosis is not an auto-immune disease. Lately there has been talk that endometriosis is an autoimmune disease because of its inflammation links. Yes, it is an inflammatory disease and reducing inflammation in the body will help it, but it is not an auto-immune disease and does not fit the classifications of an auto-immune disease either.
  1. Gynaecological conditions should be seen to by a specialist in that field and not just by a GP. While GP’s are a much needed part of healthcare, but they are just a general practitioner, they are not a specialist and a referral to a properly trained specialist should be obtained for any suspect gynaecological condition, or matters pertaining to period pain, or pelvic pain. This saves conditions being missed, or overlooked, or misdiagnosed
  2. Hysterectomy does not cure endometriosis. Most of the time endometriosis is outside the uterus and can be anywhere in the pelvic cavity. It can be on the bladder, the bowel, the fallopian tubes and it can even spread to anywhere in the body. Endometriosis has been found in the joints, around the heart, the brain and even in the eyes. Taking the uterus out is not going to cure endometriosis.

Lastly, Dr Google and many of the forums people use are not usually reliable sources of information, or a diagnosis for period pain, gynaecological conditions such as endometriosis, or any other gynaecological conditions. Only a properly trained Reproductive Medicine Specialist, Gynaecologist, Fertility Specialist, or Women’s Health Medicine Specialist can give you proper advice and education about gynaecology and matters that pertain to women’s health. You next door neighbour, your friend, your Facebook buddies are not reliable sources of information, unless they are fully qualified healthcare professional. There are some good sites out there, but even so, you still need to get advice of a proper healthcare professional and not just some person on a forum, or internet site.

I hope this helps people understand the importance of the right information and education and seeing the right people and getting investigated and managed properly. I see so many people have things missed, dismissed and overlooked and I just want to help people get the right advice and right treatments and be given the right information to save people on the heartache that many I have seen have had to endure.

If you are someone who needs help with gynaecological issues, then please get them to come and see me, or someone else who specializes in this. You can also contact Endometriosis Australia to find out who the best specialists and surgeons are. They have some great resources too. (www.endometriosisaustralia.org)

My motto will always be that “Period Pain is Not Normal” and my other motto is “Leaving No Stone Left Unturned” when it come to healthcare and helping people. If someone tells you period pain is normal, or you have to put up with it, or suck it up, you are seeing the wrong person, so please then go and see someone else.

Take care

Regards

Dr Andrew Orr

(Reproductive Medicine & Women’s Health Medicine Specialist)

“The Brisbane Baby Maker” & “Endometriosis Expert”